학술논문
CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3
Document Type
article
Author
Javier E. Cañada-García; Zaira Moure; Pedro J. Sola-Campoy; Mercedes Delgado-Valverde; María E. Cano; Desirèe Gijón; Mónica González; Irene Gracia-Ahufinger; Nieves Larrosa; Xavier Mulet; Cristina Pitart; Alba Rivera; Germán Bou; Jorge Calvo; Rafael Cantón; Juan José González-López; Luis Martínez-Martínez; Ferran Navarro; Antonio Oliver; Zaira R. Palacios-Baena; Álvaro Pascual; Guillermo Ruiz-Carrascoso; Jordi Vila; Belén Aracil; María Pérez-Vázquez; Jesús Oteo-Iglesias; the GEMARA/GEIRAS-SEIMC/REIPI CARB-ES-19 Study Group; Mariela Martínez Ramírez; Pilar Zamarrón; Miriam Albert Hernández; M. Pilar Ortega Lafont; Emilia Cercenado; Cristobal del Rosario and Jose Luis Perez Arellano; María Lecuona; Luis López-Urrutia Lorente; José Leiva and José Luis del Pozo; Salvador Giner and Juan Frasquet; Lidia Garcia Agudo and Soledad Illescas; Pedro de la Iglesia; Rosario Sánchez Benito; Eugenio Garduño; Ma Isabel Fernández Natal and Marta Arias; Marta Lamata Subero; Mar Olga Pérez Moreno; Ana Isabel López-Calleja; Luis Torres Sopena; José Manuel Azcona; Alba Belles; Mercè García González; Miriam Valverde Troya and Begoña Palop; Fernando García Garrote; Jose Luis Barrios Andrés; Leyre López Soria; Adelina Gimeno; Susana Sabater; Ester Clapés Sanchez; Jennifer Villa; Nuria Iglesias Nuñez; Rafael Sánchez Arroyo; Inmaculada García García; Susana Hernando; Cristina Seral; Javier Castillo; Eva Riquelme Bravo; Caridad Sainz de Baranda; Oscar Esparcia Rodríguez; Jorge Gaitán; María Huertas; M.a José Rodríguez Escudero; Carmen Aldea; Nerea Sanchez; Antonio Casabella Pernas; Ma Dolores Quesada; Maria Pilar Chocarro; Francisco Javier Ramos; Carmina Martí Sala; Laura Mora; Encarnación Clavijo; Natalia Chueca; Federico García; José Gutierrez Fernández; Juan Manuel Sánchez Hospital de Jérez; Fátima Galán Sánchez; Carmen Liébana; Carolina Roldán; Ma Isabel Cabeza; José María Saavedra; Ma Teresa Cabezas Fernández; Lucía Martínez Lamas; Sonia Rey Cao; Ma Isabel Paz Vidal; Raquel Elisa Rodríguez Tarazona; Amparo Coira Nieto; Ma Luisa Pérez del Molino Bernal; María Gomáriz Díaz; Matxalen Vidal-García; Jose Luis Díaz de Tuesta; Moises García Bravo; Almudena Tinajas; Andrés Canut Blasco; Ma Luz Albina Cordón Rodriguez; Nieves Gonzalo Jiménez; Genoveva Yagüe Guirao; Fe Tubau Quintano; Carmen Aspiroz; Nuria Prim; Jesús Rodríguez-Baño
Source
Frontiers in Microbiology, Vol 13 (2022)
Subject
Language
English
ISSN
1664-302X
Abstract
ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3.